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D Fig. 54a-d. Female patient Sh., age 61. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, anterior projection): the wall of the greater curvature of the distal part is disfigured and rigid, its contour is uneven (arrows). b Stomach roentgenogram (double contrast, horizontal position, anterior projection): the wall of the greater curvature of the distal part of the stomach is rigid and thick due to intramural infiltration (arrow). Conclusion: Infiltrative cancer of the greater curvature of the distal part of the stomach. c Macrospecimen: a fragment of a resected part of the stomach: the wall of the greater curvature of the distal part is firm and thick due to tumor infiltration (arrows). d Fragment of a macrospecimen (strip): the stomach wall is thickened due to white intramural infiltration (arrows). Histologically, signet-ring cell carcinoma

Thus, the analysis of condition of the greater curvature, of the anterior wall was inadequate. The specific functional and anatomical properties of the greater curvature were not taken into consideration during development of the methods for X-ray examination of the stomach, and hence in compiling a roentgenosemiotics of cancer affections (D Fig. 54). The situation is the same with primary localization of cancer on the anterior wall of the stomach body and its antral part. It is common knowledge that in almost every radiological examination the mucosal relief, including those employing compression at the phase of tight filling (a full cup of the barium meal), the relief of the posterior was inspected. In order to visualize the anterior wall at tight filling, the stomach cavity should be filled with a large amount of contrast medium. Only in this way can we see the pleats on the anterior wall by applying the slightest compression (D Figs. 55, 56). A large amount of barium sulfate is necessary to examine the greater curvature, especially at the level of the sinus, owing to its specific anatomical and functional properties [28, 31, 58, 223].

▲ Fig. 55 b.

□ Fig. 55a-d. Female patient G., age 58. Diagnosis: gastric cancer. a Stomach roentgeno-gram (tight filling, vertical position, anterior projection): contour of the greater curvature of the antral part is uneven (arrow). b, c Stomach roentgenograms (more tight filling, vertical position, anterior projection) after intake of an additional portion of the contrast medium, mild dosed compression: a depot of the contrast medium in the form of a spider with a ridge of infiltrated tissue is seen on the anterior wall of the antral part of the stomach. d Stomach roent-genogram (double contrast, horizontal position, anterior projection): impregnated ulcer crater of irregular shapes with the surrounding ridge of infiltrated tissue (arrows). Histological studies of tissue specimen taken during endoscopy failed to reveal tumor cells. Conservative anti-ulcer therapy was given

□ Fig. 56a-f. Same patient, 45 days later. a, b Stomach roentgenograms (tight filling, vertical position, anterior projection), dosed compression with application of pressure of varied strength: despite the active anti-ulcer treatment, the spider-like ulcer on the anterior wall persists; the ridge of infiltrated tissue increases, folds terminate by the periphery (arrows). c, d Stomach roentgenograms (double contrast, horizontal position, anterior projection): infiltration of the anterior wall of the antral part is ulcerated (arrow). Conclusion: Infiltrative-ulcerous cancer of the anterior wall of the antral part of the stomach. e Macrospecimen of a resected stomach: ulceration of the anterior wall of the antral part with a ridge of infiltration; the wall is firm due to intramural infiltration (arrows). f Fragment of a macrospecimen (strip): the stomach wall is thickened due to intramural infiltration (arrows). Histologically, a non-differentiated cancer.

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